Abstract
Nontuberculous mycobacteria (NTM) and many fungal species (spp.) are commonly associated with opportunistic infections (OPIs) in immunocompromised individuals. Moreover, occurrence of concomitant infection by NTM (mainly spp. of Mycobacterium avium complex and Mycobacterium abscessus complex) and fungal spp. (mainly, Aspergillus fumigatus, Histoplasma capsulatum and Cryptococcus neoformans) is very challenging and is associated with poor patient prognosis. The most frequent clinical symptoms for coinfection and infection by single agents (fungi or NTM) are similar. For this reason, the accurate identification of the aetiological agent(s) is crucial to select the best treatment approach. Despite the significance of this topic it has not been sufficiently addressed in the literature. This review aims at summarizing case reports and studies on NTM and fungi coinfection during the last 20 years. In addition, it briefly characterizes OPIs and coinfection, describes key features of opportunistic pathogens (e.g., NTM and fungi) and human host predisposing conditions to OPIs onset and outcome. The review could interest a wide spectrum of audiences, including medical doctors and scientists, to improve awareness of these infections, leading to early identification in clinical settings and increasing research in the field. Improved diagnosis and availability of therapeutic options might contribute to improve the prognosis of patients’ survival.
Highlights
Infectious diseases are still a major burden worldwide, causing critical outbreaks such as corona virus disease (COVID-19) and being a persistent cause of mortality, especially in low-income countries.Malaria, HIV/AIDS (Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome), lower respiratory tract infections including tuberculosis and diarrheal diseases, account for one-eighth of the total deaths worldwide
Nontuberculous mycobacteria (NTM) are divided into rapidly growing mycobacteria (RGM, e.g., M. fortuitum, MABC: Mycobacterium chelonae and M. abscessus), and slowly growing mycobacteria (SGM, e.g., Mycobacterium intracellulare (MAC), M. xenopi and M. kansasii) exhibiting differential epidemiology of infection
A higher proportion of candidemia caused by C. albicans was observed among newborns (60.2%), with highest rates of C. parapsilosis being observed among infants
Summary
Infectious diseases are still a major burden worldwide, causing critical outbreaks such as corona virus disease (COVID-19) and being a persistent cause of mortality, especially in low-income countries. The scope of current knowledge on fungi is very extensive and continuously updated, with basic science findings and with data collected in clinical setting (e.g., mapping occurrence, prevalence, spread and treatment of fungal disease). This information is summarized by working groups established within the International Society for Medical Mycology [9] as well as the ESCMID study group for fungi and fungal diseases [10]. We attempt to fill the gaps, summarizing the clinical significance of coinfection by two groups of opportunistic pathogens (NTM and fungi) from different kingdoms that are able to cooperate and significantly affect the disease course and treatment
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